18. Excess Office Supplies
6 mos. supply
1 year supply
… Yet they
received daily
deliveries!
$18,732 of inventory; $6,322 of it is
obsolete cartridges
18
24. Current State Value Stream Map
Outpatient Imaging Services
Pre-register
Patient
Customer Demand:
15 patients per Day
(Takt Time 1920 seconds)
8 hours per day
Schedule
Appointment
Referring
Physician
Hospital
4
3
5
Lead Time = 24 days
2
6
Lead Time = 990 mins.
Cycle Time = 30 mins.
Lead Time = 990 mins.
% C&A = 100 %
Demand = 15 per day
1
Lead Time = 12 mins.
Cycle Time = 11 mins.
Lead Time = 12 mins.
% C&A = 98 %
% C&A = 65 %
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
Symposium
E Pay
Excel
ADS
Internet
Meditech
Fax Order
Solutions
Waiting Room
Management
System
PACS
Auto Fax 50%
Us Mail 25%
MD Mailbox 25%
Rework Loop
via Fax 25% of
the time
Check-in
Patient
(Admitting)
Prep
Patient
(Tech)
Check-in
Patient
(Imaging)
Complete
Exam
(Tech)
Transmit
Images
(Tech)
Read/Dictate
Exam
(Radiologist)
Transcribe
Report
(MDI)
Review
Draft/Sign
(Radiologist)
Print
Reports
(Imaging)
Send
Reports
(Imaging)
5 mins.
5
5
5 mins.
Cycle Time = 2 mins.
% C&A = 90 %
3
6
45 mins.
Cycle Time = 1 mins.
% C&A = 98 %
5 minutes
2
7
45 minutes
2 minutes
11520
minutes
1 minutes
30 mins.
Cycle Time = 10 mins.
% C&A = 100 %
2
8
30 minutes
10 minutes
5 mins.
Cycle Time = 15 mins.
% C&A = 90 %
2
5 minutes
15 minutes
9
248 mins.
Cycle Time = 3 mins.
% C&A = 100 %
2
10
248 minutes
3 minutes
365 mins.
Cycle Time = 15 mins.
% C&A = 95 %
6
11
365 minutes
15 minutes
960 mins.
Cycle Time = 5 mins.
% C&A = 75 %
2
12
960 minutes
5 minutes
110 mins.
Cycle Time = 1 mins.
% C&A = 95 %
2
13
110 minutes
1 minutes
120 mins.
Cycle Time = 1 mins.
% C&A = 99 %
6
14
Cycle Time = 3 mins.
% C&A = 90 %
120 minutes
1 minutes
L/T = 13464 minutes
3 minutes
VA/T = 11576 minutes
Rolled First Pass
yield = 29%
25. Equipment Servicing Value Stream
Request to Cash
Source Refrigeration & HVAC, Inc.
Current State Value Stream Map
Serv ice Deliv ery
Created February 11, 2009
CONFIDENTIAL
Customer
Great
Plains
Verisae
(Customer)
Special Order
Part
Excel
Spreadsheet
(Customer)
Supplier
Tech
Upload time
card
Close call in
Verisae
Process Time
Cards
Tech
Account
Manager
(West)
Payroll Admin
PT = 0 mins.
%C&A = 70%
Batch: 1x/day
PT = 1 mins.
%C&A = 90%
Batch: 1x/day
Complete Call
in GP
Pick up Part
at Parts Store
Review
Service Call
Data
?%
Tech
40%
Receive
customer call
Select &
Dispatch Tech
Call Center
Dispatcher &
Service
Manager
5 m.
120 m.
PT = 2 mins.
%C&A = 60%
0.0833
hours
PT = 5 mins.
%C&A = 60%
Tech
PT = 90 mins.
%C&A = 90%
PT = 0 mins.
640 m.
240 m.
PT = 5 mins.
%C&A = 80%
PT = 120 mins.
%C&A = 40%
2 hours
75 minutes
Dispatcher
Tech
120 m.
1.25 hours
90 minutes
Make Repair;
Call to raise
the NTE
Get Part from
Truck
75 m.
1.5
hours
5 minutes
?%
Tech
90 m.
2 hours
2 minutes
Assess
Problem
PT = 75 mins.
%C&A = 95%
5 minutes
PT = 15 mins.
%C&A = 85%
Batch: 1x/day
Billing Admin
6 days
PT = 25 mins.
%C&A = 75%
Posting Admin
240 mins.
PT = 3 mins.
%C&A = 98%
Batch: 1x/day
640 m.
Account
Manager
3 minutes
Enter Invoices
into Verisae &
Excel; Mail
Invoices
Billing Admin
120 m.
PT = 10 mins.
%C&A = 85%
Batch: 3-5x per wk
10.7
hours
4 hours
25 minutes
Review
Invoices;
Close in
Verisae (Pac)
Review &
Post Invoices
Review Open
Ticket Report
48
hours
10 minutes
A/P Admin
PT = 10 mins.
%C&A = 90%
Batch: 1x/day
PT = 10 mins.
%C&A = 50%
Batch: 2x/day
10.7
hours
4 hours
120 minutes
Service
Manager
Process A/P
Receive
Cash; Post
Payment
Collections
60 days
PT = 4 mins.
%C&A = 95%
Batch: 1x/week
480
hours
2 hours
10 minutes
4 minutes
Lead Time = 572 hours
Process Time = 349 minutes
Acronym Key
%C&A %Complete and Accurate
AR
Activity Ratio
FTE
Full Time Equivalent
LT
Lead Time
PT
Process Time
RFPY Rolled First Pass Yield
Lead Time to invoice = 86.2 hrs
Process Time =5.9 hrs.
NOTE: Business hours
Activity Ratio = 6.8%
RFPY = 1.1%
Lead time to cash = ? days
32. Outpatient Imaging Value Stream
Current State Findings
Metric
Total Lead Time
Total Process Time
Activity Ratio (PT/LT)
Rolled First Pass Yield
(Multiply %C&A’s)
Other**
Current
State
Future
State*
%
Improvement
32.5 hrs
56 mins
2.9%
29%
Other**
Other**
* Projected until validated
** Other = Metrics for individual blocks, financials, survey or audit results, turnover,
market share, system downtime, inventory turns, hold times, work volume, etc.
32
33. Future State Value Stream Map
Outpatient Imaging Services
Standard
Work
Work
Balance
Customer Demand:
15 patients perDay
(Takt Time1920 seconds)
8 hours per day
Co-locate
Schedule appt
Pre-register
Referring
Physician
Hospital
3
Lead Time = 15 days
2
6
Demand = 15 per day
1
Lead Time = 45 mins.
Cycle Time = 11 mins.
Lead Time = 45 mins.
% C&A = 98 %
% C&A = 85 %
Risk
Reduction
(Joint
Commision)
Symposium
E Pay
Excel
Internet
Waiting Room
Management
System
Work
Balancing
Standard
Work
3
35 mins.
4
Cycle Time = 1 mins.
% C&A = 98 %
0.0833 hrs.
2
Complete
Exam
(Tech)
5
20 mins.
Cycle Time = 10 mins.
% C&A = 100 %
0.583 hrs.
1 mins.
2
Transmit
Images
(Tech)
6
5 mins.
Cycle Time = 10 mins.
% C&A = 90 %
0.333 hrs.
10 mins.
Visual
Workplace
Set-up
Reduction
Prep
Patient
(Tech)
Check-in
Patient
(Imaging)
Fax Order
Solutions
PACS
Auto Fax 80%
Us Mail 15%
MD Mailbox 5%
5S
Value Stream
Alignment
Pull System
(Supplies
Kanban)
Remove
Check in
and Reduce
System Access
5 mins.
Meditech
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
2
7
120 mins.
2
Review
Draft/Sign
(Radiologist)
420 mins.
Cycle Time = 15 mins.
% C&A = 95 %
2 hrs.
2 mins.
8
Batch
Reductions
Voice
Recognition
Read/Dictate
Exam
(Radiologist)
Cycle Time = 2 mins.
% C&A = 100 %
0.0833 hrs.
10 mins.
Continuous
Flow
2
Print
Reports
(Imaging)
9
2 mins.
Cycle Time = 1 mins.
% C&A = 95 %
7 hrs.
15 mins.
Rework Loop
via Fax 10% of
the time
2
30 mins.
Cycle Time = 1 mins.
% C&A = 99 %
0.0333 hrs.
1 mins.
10
Send
Reports
(Imaging)
6
0.5 hrs.
1 mins.
11
Cycle Time = 3 mins.
% C&A = 90 %
LT = 11.3 hrs.
3 mins.
CT = 43 mins.
CT/LT Ratio = 6.32%
Rolled First Pass
VSM Champion: Paul Scanneryield = 40%
Created: July 18, 2007
34. Outpatient Imaging
Value Stream Improvement Results
Current
State
Future
State
%
Improvement
32.5 hrs
56 mins
11.3 hrs
43 mins
65%
23%
Activity Ratio
Rolled First Pass Yield
2.9%
29%
6.3%
40%
117%
38%
Annual turnover
100%
25%
75%
14
11
21%
Metric
Total Lead Time
Total Process Time
# handoffs
Note: Freed capacity (reduced PT) allowed the facility to collect an add’l
$500,000 in revenue without adding equipment or staff.
34
40. Root Cause Analysis: 4 Key Tools
Cause-and-Effect Diagram
5 Why’s
People
Material / Info
Lack of experience
Budgets
Submitted Late
Forecast in other system
Manual vs. PC
System avail.
Quality issue requiring
rework
Staffing/absenteeism
Order entry error
Changing customer
requirements w/ no
adjustment to expected
delivery
Equipment failure
Tally
||||| ||
|||||
|||
||||| |||||
||||| ||||| |||
|
No standard work
Email vs. FedEx
Check Sheets Quantify Occurrences
Material shortage
Changing schedule
Input rec’d late
No sense of import
Machine
Reason
No stnd spread sheet
Time availability
Why?
Why?
Why?
Why?
Why?
Method
No milestones
$ vs. units
Measurement
Weather delays
Dispersed sales force
Environment
41. Future State Design Considerations
Improve quality
Eliminate steps / handoffs
Combine steps
Create parallel paths
Alter task sequencing
and/or timing
Implement pull
Reduce / eliminate batches
Create an organized, visual
workplace
Reduce interruptions, setup
and changeover
Eliminate motion &
transportation
Standardize & errorproof work
Eliminate unnecessary
approvals /
authorizations
Stop performing nonvalue adding (NVA)
tasks
Co-locate functions
based on flow; create
cells (teams of crossfunctional staff)
Balance work to meet
takt time requirements
41
45. Create an Action Plan: Who, What, When, Where, and How?
Future State Implementation Plan
Value Stream Outpatient Imaging
Implementation Plan Review Dates
Executive Sponsor Allen Ward
11/1/2007
Value Stream Champion Sally McKinsey
11/21/2007
Value Stream Mapping Facilitator Dave Parks
12/13/2007
Date Created 10/18/2007
Block
#
2
Goal / Objective
Improve quality of referral
Improvement Activity
Type
KE
Implement standard work for referral
process
Owner
Sean O'Ryan
PROJ
1/10/2008
Implementation Schedule (weeks)
2 3 4 5 6 7 8 9 10 11 12
Dianne
Prichard
3, 4
Reduce lead time beween schedulingand
Cross-train and colocate work teams
preregistration steps
5, 6
Eliminate the need for two patient checkins
Collect copays in Imaging
KE
Michael
O'Shea
6
Eliminate bottleneck in waiting area
Balance work / level demand
KE
Dianne
Prichard
9
Eliminate lead time associated with
transcription step
Implement voice recognition technology
PROJ
Sam Parks
10
Eliminate batched reading
Reduce setup required
KE
Sam Parks
7
Reduce inventory costs, regulatory risk
and storage needs
5S CT supplies area; implement kanban
KE
Michael
O'Shea
12
Reduce delay in report delivery
Implement additional fax ports
PROJ
Martha Allen
12
Reduce delay in report delivery
Increase percentage of physicians
receiving electronic delivery (rather than
hard copy)
KE
1
Martha Allen
Approvals
Executive Sponsor
Value Stream Champion
Value Stream Mapping Facilitator
Signature:
Signature:
Signature:
Date:
Date:
Date:
Type: KE = Kaizen Event; PROJ = Project; JDI = Just do it
Date
Complete
46. Kaizen Events & Projects
• Document & analyze the
current state
• Design future state
• Brainstorm &
prioritize solutions
• Design & develop
improvements
Plan
Act
• Refine & finalize
improvements
• Implement
improvements
• Train workforce
Macro
PDCA
Plan
Check
• Test improvements
Do
Act
Do
Check
46
49. Building a C.I. Culture
“Life is Good” Stage
Years 5 & Beyond
Company-wide engagement –
everywhere, all the time
Support needed only for
audits, bandwidth gaps,
continued learning
• Daily kaizen is the norm
• “Action now” dominates
• Most processes are
stabilized with minimal waste
and output variation
“Settling In” Stage
Years 3 & 4
More staff engagement –
reduced need for formal
Kaizen Events
Light support from
seasoned improvement
professionals
• Demonstrating learned
competencies
• Process owners manage
performance
• Becoming more proactive
“Disruption” Stage
Years 1 & 2
Small percentage of staff
engaged – project-based
Heavy support from
seasoned improvement
professionals
• Sensei-dominated
• Much mentoring & learning
• Heavy use of Kaizen Events
• Many issues to be resolved
49
52. For Further Questions
7770 Regents Road #635
San Diego, CA 92122
858.677.6799
ksm@ksmartin.com
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52